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Rising PSA post robotic surgery

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User
Posted 11 Jun 2017 at 11:19
Hi my first post here:

I had a robotic prostatectomy 20 months ago, prior to surgery my PSA was 4.8, 6 months post op it was less than 0.008, 20 months post op it has gone up to 0.024. My post op staging was T3A with no other involvement and all 3+3 and clear margins. Naturally I am concerned about recurrence and further treatment, my URO wants to avoid over treatment but he referred me to the ONC for a second opinion, the ONC agrees but has sent me for a bone scan anyway. Other posts seem to be having ajunct or salvage RT at my PSA level so the uncertainty and differing treatment recomendations are unsettling.

Thoughts anyone??

User
Posted 11 Jun 2017 at 14:31

Franc, the ultra-sensitive PSA test has been rather brought into disrepute recently and a number of hospitals are no longer offering it, preferring to go back to testing to 1 decimal place. Even if your PSA test was reliable you are still at only 15% of what would be considered unacceptable for a man with no prostate and at the moment your PSA would be about the same as a woman that has just had an orgasm or is breast-feeding.

Guidance on when salvage RT is needed is based on the NICE definition of chemical recurrence which is a) PSA over 0.2 or b) 3 successive rises over 0.1 - you are nowhere near the threshold. The criteria for adjuvant RT is usually a first post-op PSA over 0.2 and / or positive margins.

The fact that your PSA appears to be rising may be indicative of further treatment needed in the future but I think at the moment the jury is out.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 07 Jul 2017 at 03:49
Ok ONC sent me for a bone scan which has been reviewed as clear. Given the low PSA and all grade 6 at final pathology I have decided with ONCs support to not have anther PSA for 6 months. Logic being in 3 months it's not likely to have reached a threshold where RT would be recomended but the PSA stress is real and life impacting. In 6 months I will have the same stress but if it's gone up significantly I will take further action having had 6 months without PSA roulette!

Good news is the ED seems to be improving at last after nearly 2 years post op can now get a semi usable result without any tablets. I think I am a good example of it not being to late to try the full rehab (vacuum and daily ciallis) approach even though I did nothing for 12 months as my delightful X wife of 34 years decided to bugger off 6 months post OP - not been the best 2 years! Anyway online dating is amazing and has yielded an understanding friend who has restored my faith in Women :-). Gotta keep at it, life that is! !

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User
Posted 11 Jun 2017 at 13:51

Francij4

This has been the most confusing thing for me, too.  Post-prostatectomy, I was pT3b with Gleason 9.  6 weeks after surgery, PSA 0.014.  4 months after surgery, 0.019.  I have my next PSA test in just over a week.

My oncologist told me prior to surgery she didn't believe in early or adjuvant radiotherapy.  After my surgery, she told me that as I had positive margins, I may well benefit from early radiotherapy, but as my PSA was so low, she'd prefer to wait.  In the end though, she gave me the choice.

I was comfortable to postpone, but now I think I want to go ahead.  From research, it seems the decision to go ahead with early radiotherapy should be based not on PSA but on the state of affairs in the lab post-prostatecomy.  The problem is, there is no settled view on this.  

I see my oncologist in 10 days' time.  Let's see what she says.  

Ulsterman

User
Posted 11 Jun 2017 at 14:31

Franc, the ultra-sensitive PSA test has been rather brought into disrepute recently and a number of hospitals are no longer offering it, preferring to go back to testing to 1 decimal place. Even if your PSA test was reliable you are still at only 15% of what would be considered unacceptable for a man with no prostate and at the moment your PSA would be about the same as a woman that has just had an orgasm or is breast-feeding.

Guidance on when salvage RT is needed is based on the NICE definition of chemical recurrence which is a) PSA over 0.2 or b) 3 successive rises over 0.1 - you are nowhere near the threshold. The criteria for adjuvant RT is usually a first post-op PSA over 0.2 and / or positive margins.

The fact that your PSA appears to be rising may be indicative of further treatment needed in the future but I think at the moment the jury is out.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 13 Jun 2017 at 01:55
Thanks I had read your post with interest as the figures looked similar. I must admit I am starting to realise having the PSA test is both a blessing and curse, part of me thinks just don't bother and see what happens but that would be the way of the ostrich!
User
Posted 07 Jul 2017 at 03:32
good news on the latest PSA ulster man :-)

User
Posted 07 Jul 2017 at 03:49
Ok ONC sent me for a bone scan which has been reviewed as clear. Given the low PSA and all grade 6 at final pathology I have decided with ONCs support to not have anther PSA for 6 months. Logic being in 3 months it's not likely to have reached a threshold where RT would be recomended but the PSA stress is real and life impacting. In 6 months I will have the same stress but if it's gone up significantly I will take further action having had 6 months without PSA roulette!

Good news is the ED seems to be improving at last after nearly 2 years post op can now get a semi usable result without any tablets. I think I am a good example of it not being to late to try the full rehab (vacuum and daily ciallis) approach even though I did nothing for 12 months as my delightful X wife of 34 years decided to bugger off 6 months post OP - not been the best 2 years! Anyway online dating is amazing and has yielded an understanding friend who has restored my faith in Women :-). Gotta keep at it, life that is! !

 
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